Provider Demographics
NPI:1932227337
Name:ACTIVE CARE CHIROPRACTIC INC
Entity type:Organization
Organization Name:ACTIVE CARE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-554-7661
Mailing Address - Street 1:3240 LONE OAK RD STE C
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-0370
Mailing Address - Country:US
Mailing Address - Phone:270-554-7661
Mailing Address - Fax:270-554-7683
Practice Address - Street 1:3240 LONE OAK RD STE C
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0370
Practice Address - Country:US
Practice Address - Phone:270-554-7661
Practice Address - Fax:270-554-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty